Healthcare Provider Details

I. General information

NPI: 1801000971
Provider Name (Legal Business Name): CELINE ALYSSA HAMILTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date: 07/17/2007
Reactivation Date: 06/13/2008

III. Provider practice location address

2525 EMBASSY DR STE 16
HOLLYWOOD FL
33026-4573
US

IV. Provider business mailing address

2525 EMBASSY DR STE 16
HOLLYWOOD FL
33026-4573
US

V. Phone/Fax

Practice location:
  • Phone: 714-614-2873
  • Fax:
Mailing address:
  • Phone: 714-614-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME134945
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number242821
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number242821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: